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Growth mindset, the belief that personal attributes such as intelligence are malleable, has previously been related to more effort investment. Here, we investigated how undergraduates' mindset (N = 114) relates to the choice to invest effort during an arithmetic task, indexed by whether they make low vs. high effort-related choices. Social cognitive theory suggests that past performance experiences (mastery vs. failure) and physiological state are important sources for competence self-evaluations. Therefore, in addition to mindset, we also investigated how effort-related choices are influenced more dynamically, by failures and physiological responses during the task. Growth mindset and physiological effort mobilization did not predict effort-related choices but making mistakes did predict lower effort choices in the subsequent round. This study further supports the importance of mastery experiences for effort investment and provides a novel approach for integrating different levels of influence on effort-related choices during an educationally-relevant task.

There is increased use of neoadjuvant fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) in the management of localized pancreatic ductal adenocarcinoma (PDAC), yet there are few validated biomarkers of treatment response.Consecutive patients (n = 196) with resectable, borderline resectable or locally advanced PDAC (2012-2019) receiving FOLFIRINOX as initial treatment and with targeted sequencing of a pretreatment biopsy were identified in a prospective institutional database. Genomic alterations were determined in the 4 driver mutations (KRAS, TP53, CDKN2A, SMAD4), and associations between genomic alterations and clinical outcomes were assessed.Alterations in KRAS (n = 172, 87.8%) and TP53 (n = 131, 66.8%) were common; alterations in CDKN2A (n = 49, 25.0%) and SMAD4 (n = 36, 18.4%) were less frequently observed. A total of 105 patients (53.6%) were able to undergo resection, of whom 8 (7.6%) had a complete/near-complete pathologic response. There were no somatic alterations associated with major pathologic response. Alterations in SMAD4 were associated with a lower rate of surgical resection (27.8% vs 59.4%, p0.001); this was additionally observed in a multivariable regression model accounting for resectability status (OR 0.35, 95% confidence interval [CI] 0.15-0.85). Thirty-three patients (16.8%) developed metastatic disease while on neoadjuvant therapy. SMAD4 alterations were associated with a significant risk of metastatic progression on therapy when controlling for resectability status (OR 3.31, 95% CI 1.44-7.60).SMAD4 alterations are associated with more frequent development of metastasis during neoadjuvant FOLFIRINOX and lower probability of reaching surgical resection. Evaluation of alternative chemotherapy regimens in patients with SMAD4 alterations will be important to distinguish whether this represents a prognostic or predictive biomarker.

Objective Privacy is a concern whenever individual patient health data is exchanged for scientific research. We propose using mixed sum-product networks (MSPNs) as private representations of data and take samples from the network to generate synthetic data that can be shared for subsequent statistical analysis. This anonymization method was evaluated with respect to privacy and information loss. Materials and methods Using a simulation study, information loss was quantified by assessing whether synthetic data could reproduce regression parameters obtained from the original data. Predictors variable types were varied between continuous, count, categorical, and mixed discrete-continuous. Additionally, we measured whether the MSPN approach successfully anonymizes the data by removing associations between background and sensitive information for these datasets. Results The synthetic data generated with MSPNs yielded regression results highly similar to those generated with original data, differing less than 5% in most simulation scenarios. Standard errors increased compared to the original data. Particularly for smaller datasets (1000 records), this resulted in a discrepancy between the estimated and empirical standard errors. Sensitive values could no longer be inferred from background information for at least 99% of tested individuals. Discussion The proposed anonymization approach yields very promising results. Further research is required to evaluate its performance with other types of data and analyses, and to predict how user parameter choices affect a bias-privacy trade-off. Conclusion Generating synthetic data from MSPNs is a promising, easy-to-use approach for anonymization of sensitive individual health data that yields informative and private data.

On-site deferral for low hemoglobin (Hb) is common in most countries and deferral rates commonly vary between 1% and 20%. Blood banks continuously strive to reduce deferral rates as these imply an immediate loss of products, a waste of materials, a waste of staff and donor time, and potential loss of donors. Despite many efforts, the main cause of donor deferral-the variability in hemoglobin measurement outcomes-remains largely unaddressed.Repeated hemoglobin measurements obtained at donor intake were used to estimate the variability in measurement outcomes (measurement variability). This information is incorporated in a new algorithm for donor deferral where the mean hemoglobin level of a donor is used to determine both donor eligibility and the deviance of individual measurement outcomes. The algorithm was tested on a cohort of new Dutch donors that started between 2012 and 2022 to evaluate its impact on the donor deferral rate.Historical data from 439,376 new donors with a deferral rate of 5.3% were analyzed by applying the new donor deferral algorithm. It was found that 92% of all deferrals were unnecessary as Hb levels were within the range of expected measurement variability. Contrarily, it appeared that 460 donors (0.10%) made 704 donations (0.06%) whilst not complying with donor eligibility criteria.Not accounting for measurement variability can be shown to not only result in unnecessary on-site deferrals but also results in donations by donors that can be shown not to comply with the legally required minimum Hb levels.

Background: Neoadjuvant treatment for pancreatic ductal adenocarcinoma (PDAC) has increased, necessitating histopathologic confirmation of cancer. This study evaluates the performance of endoscopic tissue acquisition (TA) procedures for borderline resectable and resectable PDAC. Methods: Pathology reports of patients included in two nationwide randomized controlled trials (PREOPANC and PREOPANC-2) were reviewed. The primary outcome was sensitivity for malignancy (SFM), considering both “suspicious for” and “malignant” as positive. Secondary outcomes were rate of adequate sampling (RAS) and diagnoses other than PDAC. Results: Overall, 892 endoscopic procedures were performed in 617 patients, including endoscopic ultrasonography (EUS)-guided TA in 550 (89.1%), endoscopic retrograde cholangiopancreatography (ERCP)-guided brush cytology in 188 (30.5%), and periampullary biopsies in 61 patients (9.9%). The SFM was 85.2% for EUS, 88.2% for repeat EUS, 52.7% for ERCP, and 37.7% for periampullary biopsies. The RAS ranged 94–100%. Diagnoses other than PDAC were other periampullary cancers in 24 (5.4%), premalignant disease in five (1.1%), and pancreatitis in three patients (0.7%). Conclusions: EUS-guided TA of patients with borderline resectable and resectable PDAC included in RCTs had an SFM above 85% for both first and repeat procedures, meeting international standards. Two percent had false positive result for malignancy and 5% had other (non-PDAC) periampullary cancers.

The SARS-CoV-2 pandemic's unpredictability and ambiguity, combined with the lockdown, social distancing, containment measures, and economic impact could increase the risk of mental health issues.To assess the magnitude of mental health outcomes and risk factors among Moroccans, using an online survey, during the SARS-CoV-2 outbreak.This cross-sectional, survey-based study collected demographic data and mental health measurements from 11,123 participants. The degree of depression, anxiety, and insomnia symptoms were assessed by the 9-item Patient Health Questionnaire, the 7-items Generalized Anxiety disorder, and the 7-items Insomnia Severity Index.The survey was completed by 11,123 individuals out of a total of 15,008 contacts. 7315 (65.8%) were women, and 7182 (64.6%) were aged 18 to 34. A significant proportion of respondents experienced depression (5894 [53%]), anxiety (5544 [49.8%]), and insomnia (4410 [39.6%]). Multivariable logistic regression analysis showed that being a woman, being married, and being a parent of children aged less than five years were associated with severe symptoms of depression and anxiety (e.g. severe depression among women vs. men (OR, 1.19; 95%CI, 1.06-1.33; P = .003), severe depression among married compared to unmarried respondents (OR, 1.92; 95%CI, 1.71-2.16; P .000), e.g. severe anxiety among women vs. men (OR, 1.40; 95%CI, 1.24-1.58;0.000), severe anxiety among married people compared to unmarried (OR, 1.14; 95%CI, 1.00-1.28; P .003).Our findings reported a significant mental health burden on the general public during the COVID-19 lockdown. In addition to efforts deployed to prevent the spread of the disease, timely and culturally-specific mental health care needs to be developed urgently.

Background and objectives: Current genotyping techniques allow typing of all relevant red cell, human leukocyte and platelet antigens in a single analysis. Even genetic markers related to donor health can be added. Implementation of this technology will affect various stakeholders within the transfusion chain. This study aims to systematically map the anticipated advantages and disadvantages of a national rollout of blood group genotyping of donors, which will affect the availability of rare donors and the implementation of an extensively typed blood transfusion policy. Materials and methods: Two focus-group sessions were held with a wide representation of stakeholders, including representatives of donor and patient organisations. A dedicated software tool was used to collect the reflections of participants on genotyping for blood group antigens and extensive matching. Additionally, stakeholders and experts discussed various prepared propositions. All information collected was categorised. Results: From 162 statements collected, 59 statements (36%) were labelled as 'hopes' and 77 (48%) as 'fears'. Twenty-six (16%) statements remained unlabelled. The statements were divided in 18 categories under seven main themes: patient health, genotyping, privacy issues and ethical aspects, donor management, inventory management and logistics, hospital and transfusion laboratory and general aspects. The discussion on the propositions was analysed and summarised. Conclusion: Stakeholders believe that a genotyped donor pool can result in a reduction of alloimmunization and higher availability of typed blood products. There are concerns regarding logistics, costs, consent for extended typing, data sharing, privacy issues and donor management. These concerns need to be carefully addressed before further implementation.

The COVID-19 pandemic negatively impacted adolescent mental health on a global scale. However, many students were resilient during this crisis, despite exposure to COVID-related stressors. We aimed to study the protective effects of growth mindset on school-related resilience during the COVID-19 pandemic, and the mediating effects of coping styles. The two-year follow-up of an ongoing Randomized Controlled Trial, involving a growth mindset and control intervention, took place during the pandemic. We measured growth mindset, school burnout symptoms, COVID-19-specific stressor exposure, coping styles, and calculated a resilience score (corrected for pre-pandemic school burnout symptoms). Mediation analyses were performed in the total sample (N = 261), and exploratory in the intervention subsamples, to test whether the associations between mindset and resilience were mediated by coping styles. Growth-mindset students were more resilient during the pandemic and used less maladaptive and more adaptive (acceptance) coping styles. Coping mediated the relation between mindset and resilience in the total sample (both coping styles), and growth mindset intervention subsample (maladaptive coping). We found unique evidence for the beneficial effects of growth mindset on school-related resilience during the pandemic, and the mediating effect of coping styles as explanatory mechanism. This work contributes to a growing literature that shows positive effects of growth mindset on mental health.

OBJECTIVES This study aimed to investigate the impact of mechanical factors at baseline on the patency of a restorative conduit for coronary bypass grafts in an ovine model at serial follow-up up to 1 year. METHODS The analyses of 4 mechanical factors [i.e. bending angle, superficial wall strain and minimum and maximum endothelial shear stress (ESS)] were performed in 3D graft models reconstructed on baseline (1-month) angiograms frame by frame by a core laboratory blinded for the late follow-up. The late patency was documented by Quantitative Flow Ratio (QFR®) that reflects the physiological status of the graft. The correlation between 4 mechanical factors and segmental QFR (△QFR) were analysed on 10 equal-length segments of each graft. RESULTS A total of 69 graft geometries of 7 animals were performed in the study. The highest △QFR at 12 months was colocalized in segments of the grafts with the largest bending angles at baseline. Higher △QFR at 3 months were both at the anastomotic ends and were colocalized with the highest superficial wall strain at baseline. High baseline ESS was topographically associated with higher △QFR at the latest follow-up. Correlations of minimum and maximum ESS with △QFR at 3 months were the strongest among these parameters (ρ = 0.30, 95% CI [−0.05 to 0.56] and ρ = 0.27, 95% CI [−0.05 to 0.54], respectively). CONCLUSIONS Despite the limited number of grafts, this study suggests an association between early abnormal mechanical factors and late flow metrics of the grafts. The understanding of the mechanical characteristics could help to improve this novel conduit.

The study aim was to appraise the relevance and appropriateness of an interprofessional prenatal oral care model among pregnant women and healthcare providers in British Columbia (BC), Canada. Audio-recorded semi-structured interviews with 39 purposefully selected participants (13 pregnant women and 26 healthcare professionals) were used qualitatively to appraise relevance of an existing model. The existing model emphasizes communication and collaboration among multiple health providers for the delivery of integrated prenatal oral care. All interviews were transcribed verbatim and analyzed using an inductive thematic approach and N-Vivo® software. During the first round of interviews, most participants considered the existing model as simple and well-defined but not fully relevant to the BC context. The participants suggested revisions to Steven's model to incorporate facilitators of integrated care, including interprofessional education, oral health funding, and advocacy for oral healthcare. Participants suggested a different graphical portrayal for the revised model; an implementation guide was also suggested. A revised model based on participants' feedback, was shared with 14 of the initial participants during secondary interviews. Further evaluation of the appropriateness of the revised model is warranted.

Mass-scale red blood cell genotyping of donors and transfusion recipients increases the availability of extended antigen matched red blood cell units. Therefore, a new mathematical framework is developed that can be applied for general blood groups (i.e., beyond the ABO, RhD blood groups). It determines which red blood cell units should be issued from inventory, such that requests from hospitals can be satisfied with antigen compatible red blood cell units, shortages for future requests are avoided, and outdating is prevented. The optimization model consists of two steps: a binary vector representation for general blood groups and the formulation of the inventory allocation problem as a minimum cost flow problem. The potential practical performance of the optimization model is evaluated by iterative simulations, based on historical data on supply and demand of red blood cell units in the Netherlands. When including the fourteen clinically most relevant antigens, more than 90% of all requests can be satisfied with antigen identical red blood cell units. Shortages and outdating can be kept restricted and could even be reduced to virtually zero, when only the ABO, RhD blood groups are considered.

The study of the residual lifetime received considerable attention in survival analysis and in other disciplines like reliability theory and actuarial science. The quantile residual lifetime function, the inverse of the residual lifetime distribution P(T-1 - t(1) t(1)), provides an interesting and well-studied measure to analyse residual lifetimes. In this paper we generalize the residual lifetime distribution and the quantile residual lifetime function by adding an extra conditioning of the form {T-2 t(2)}, where T-2 is a second variable containing extra information on T-1. Wepropose, for right-censored lifetimes, nonparametric estimators for this generalized conditional remaining lifetime distribution and the corresponding quantile function and we derive the asymptotic theory. In a simulation study, we show the good performance of the newly proposed quantile estimators and we discuss an application to real data on primary biliary cirrhosis.

The Mann-Kendall test for trend has gained a lot of attention in a range of disciplines, especially in the environmental sciences. One of the drawbacks of the Mann-Kendall test when applied to real data is that no distinction can be made between meaningful and non-meaningful differences in subsequent observations. We introduce the concept of partial ties, which allows inferences while accounting for (non)meaningful difference. We introduce the modified statistic that accounts for such a concept and derive its variance estimator. We also present analytical results for the behavior of the test in a class of contiguous alternatives. Simulation results which illustrate the added value of the test are presented. We apply our extended version of the test to some real data concerning blood donation in Europe., Comment: 19 pages, 1 figure

The question of how learners’ motivation influences their academic achievement and vice versa has been the subject of intensive research due to its theoretical relevance and important implications for the field of education. Here, we present our understanding of how influential theories of academic motivation have conceptualized reciprocal interactions between motivation and achievement and the kinds of evidence that support this reciprocity. While the reciprocal nature of the relationship between motivation and academic achievement has been established in the literature, further insights into several features of this relationship are still lacking. We therefore present a research agenda where we identify theoretical and methodological challenges that could inspire further understanding of the reciprocal relationship between motivation and achievement as well as inform future interventions. Specifically, the research agenda includes the recommendation that future research considers (1) multiple motivation constructs, (2) behavioral mediators, (3) a network approach, (4) alignment of intervals of measurement and the short vs. long time scales of motivation constructs, (5) designs that meet the criteria for making causal, reciprocal inferences, (6) appropriate statistical models, (7) alternatives to self-reports, (8) different ways of measuring achievement, and (9) generalizability of the reciprocal relations to various developmental, ethnic, and sociocultural groups.

BACKGROUND AND OBJECTIVES There is a growing concern for the transmission of arboviral infections by blood transfusion in Europe. However, no assessment of the risk of transmission through all European blood supplies has been reported. Risk regulations at a European level should take differences in local transmission risk and the risk of transmission by travelling donors into consideration. MATERIALS AND METHODS A risk model and publicly available tool were developed to calculate the risk of transmission by all European blood supplies for arboviral outbreaks within Europe. Data on individual European blood supplies from Council of Europe reports and inter-European travel data from EUROSTAT were used to populate this model. RESULTS Each neuroinvasive case of WNV reported in Europe will on average result in 0·43 (95%CI: 0·32-0·55) infected blood product by locally infected donors and 0·010 (95%CI: 0·006-0·015) infected products by travelling donors. On basis of the 1373 neuroinvasive human WNV cases reported in the outbreak of 2018, it is estimated that without safety interventions this outbreak would have resulted in 708 (95%CI: 523-922) infected components derived from resident donors. Noncompliance to European regulations, which requires donor deferral or testing of donors who visited WNV-infected areas, would have resulted in 7.4 (95%CI: 4·7-11·1) infected blood components derived from infectious travelling donors exposed in outbreak areas throughout Europe. CONCLUSION The risk of WNV transmission by a local outbreak is on average 113 times (95%CI: 95-139), so two orders of magnitude higher than the risk of transmission by travelling donors in Europe.

Funder: European Association for Research on Learning and Instruction, Funder: Jacobs Foundation; Id: http://dx.doi.org/10.13039/501100003986, As the field of educational neuroscience continues to grow, questions have emerged regarding the ecological validity and applicability of this research to educational practice. Recent advances in mobile neuroimaging technologies have made it possible to conduct neuroscientific studies directly in naturalistic learning environments. We propose that embedding mobile neuroimaging research in a cycle (Matusz, Dikker, Huth, & Perrodin, 2019), involving lab-based, seminaturalistic, and fully naturalistic experiments, is well suited for addressing educational questions. With this review, we take a cautious approach, by discussing the valuable insights that can be gained from mobile neuroimaging technology, including electroencephalography and functional near-infrared spectroscopy, as well as the challenges posed by bringing neuroscientific methods into the classroom. Research paradigms used alongside mobile neuroimaging technology vary considerably. To illustrate this point, studies are discussed with increasingly naturalistic designs. We conclude with several ethical considerations that should be taken into account in this unique area of research.

Background Risk‐based decision making is increasingly recognized as key to support national blood policy makers and blood operators concerning the implementation of safety interventions, especially to address emerging infectious threats and new technology opportunities. There is an urgent need for practical decision support tools, especially for low‐ and middle‐income countries that may not have the financial or technical capability to develop risk models. WHO supported the development of such a tool for blood safety. The tool enables users to perform both a quantitative Multi‐Criteria Decision Assessment and a novel step‐by‐step qualitative assessment. Study Design and Methods This paper summarizes the content, functionalities, and added value of the new WHO tool. A fictitious case study of a safety intervention to reduce the risk of HIV transmission by transfusion was used to demonstrate the use and usefulness of the tool. Results Application of the tool highlighted strengths and weaknesses of both the quantitative and qualitative approaches. The quantitative approach facilitates assessment of the robustness of the decision but lacks nuances and interpretability especially when multiple constraints are taken into consideration. Conversely, while unable to provide an assessment of robustness, the step‐by‐step qualitative approach helps structuring the thought process and argumentation for a preferred intervention in a systematic manner. Conclusion The relative strengths and weaknesses of the quantitative and step‐by‐step qualitative approach to risk‐based decision making are complementary and mutually enhancing. A combination of the two approaches is therefore advisable to support the selection of appropriate blood safety interventions for a particular setting.

Background Pancreatic enzyme-replacement therapy (PERT), provided as pancreatin to patients with pancreatic exocrine insufficiency (PEI), is considered an essential substitute for the pivotal physiological function the pancreas fulfills in digestion. PEI involves a reduction in the synthesis and secretion of pancreatic enzymes (lipase, protease, amylase), which leads to an inadequate enzymatic response to a meal and consequently to maldigestion and malabsorption of nutrients. The efficacy of PERT is strongly dependent on enzyme activity, dissolution, and pancreatin particle size. Objective The physiological properties of eight pancreatin preparations (nine batches; five different brands) available in Russia and CIS (Commonwealth of Independent States: Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Uzbekistan) were investigated. Methods The lipase activity, dissolution, and particle size distribution of samples from multiple batches of pancreatin of different strengths were measured. Results Regarding lipase activities, all pancreatin preparations except Micrazim® matched the labeled content. Considerable differences were observed in particle size and dissolution. Conclusion Pancreatin preparations available in Russia and CIS demonstrate product-to-product and batch-to-batch variability regarding the measured properties of lipase activity, dissolution, and particle size. This may impact the efficacy of PERT and therefore clinical outcomes.

Background: Value Based Health Care (VBHC) is a well-known strategy in most countries, amongst whom the Netherlands, to improve patient-relevant outcomes and reduce healthcare costs. However, a met...

Objective: The current study examined instrumental learning in ADHD. Method: A total of 58 children with ADHD and 58 typically developing (TD) children performed a probabilistic learning task using three reward probability conditions (100%, 85%, 70% reward). After a learning phase, application of what was learned was assessed in a test phase. Results: Results showed that children with ADHD performed less accurate compared with TD children during the learning phase, particularly in the 100% and 85% reward probability conditions. These findings were accompanied by a blunted learning rate in the first few task trials. Furthermore, children with ADHD showed poorer application of what was learned. Conclusion: To conclude, children with ADHD show initial learning problems, but increased performance in a similar manner as TD children independent of the probability of reward, although they fail to apply their knowledge. Findings are of clinical relevance as the application of knowledge is important to successfully adapt to daily challenges in life.

Blood supply chain management requires estimates about the demand of blood products. The more accurate these estimates are, the less wastage and fewer shortages occur. While the current literature demonstrates tangible benefits from statistical forecasting approaches, it highlights issues that discourage their use in blood supply chain optimization: there is no single approach that works everywhere, and there are no guarantees that any favorable method performance continues into the future.We design a novel autonomous forecasting system to solve the aforementioned issues. We show how possible changes in blood demand could affect prediction performance using partly synthetic demand data. We use these data then to investigate the performances of different method selection heuristics. Finally, the performances of the heuristics and single method approaches were compared using historical demand data from Finland and the Netherlands. The development code is publicly accessible.We find that a shift in the demand signal behavior from stochastic to seasonal would affect the relative performances of the methods. Our autonomous system outperforms all examined individual methods when forecasting the synthetic demand series, exhibiting meaningful robustness. When forecasting with real data, the most accurate methods in Finland and in the Netherlands are the autonomous system and the method average, respectively.Optimal use of method selection heuristics, as with our autonomous system, may overcome the need to constantly supervise forecasts in anticipation of changes in demand while being sufficiently accurate in the absence of such changes.

Background The Netherlands Heart Network is a joint-effort of all relevant healthcare providers in primary, secondary, and tertiary care across the complete care chain in a region with an adherence of approximately 1,000,000 inhabitants. This regional collaboration features four non-academic hospitals, over 450 general practitioners and various other healthcare professionals who cooperate for the continuous improvement of cardiac patient care using Value Based Healthcare principles. Purpose Due to predicted demographic changes and the expected rise of cardiovascular diseases, novel initiatives are needed to optimize present-day healthcare systems. Therefore, the NHN has focused on the implementation of transmural integrated care delivery systems and impactful innovations for four major cardiovascular diseases: atrial fibrillation (AF), heart failure (HF), coronary artery disease and valvular diseases. Methods Various new health care initiatives and innovations have been implemented and evaluated in the region. For example, dedicated outpatient clinics and transmural care standards have been implemented for AF and HF across the full care cycle. The effect of the implementation of these care standards on patient-relevant outcomes and healthcare costs has been evaluated using large scale prospective and retrospective quality registries. Furthermore, new health care innovations include, among others, the opportunistic screening for AF within general practices and an optimized pre-hospital triage protocol for NSTEMI patients. Results Patient-relevant outcomes in 446 AF patients who visited dedicated outpatient clinics improved within 6 months of follow-up (EHRA score (1.93 to 1.36; p Conclusion(s) This regional collaboration by health professionals is unique in its approach and highlights that healthcare improvements are not exclusively reserved to large academic centers or referral hospitals. The present approach may serve as a blueprint for the organization of healthcare in other regions. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMWHealth insurance CZ/VGZ

The Interactions website (interactions.acm.org) hosts a stable of bloggers who share insights and observations on HCI, often challenging current practices. Each issue we'll publish selected posts from some of the leading and emerging voices in the field.

Pneumothorax is a common pathology, but optimal management strategies are not yet defined. There are significant differences in international guidelines and therefore variation in clinical practice.There is increasing interest in pneumothorax research, particularly primary spontaneous pneumothorax (PSP), with evidence of lung abnormalities in this group without clinically apparent lung disease and recently completed clinical trials aiming to optimize management. The most robust evidence base is that of the equivalence of needle aspiration and chest tube insertion for initial management of PSP; although, patients with secondary spontaneous pneumothorax may also benefit. A convincing case for surgical intervention or thoracoscopy and talc poudrage to prevent recurrence at first episode in PSP has yet to be made. Clinicians should be vigilant for PSP being the first manifestation of a systemic disease, and should have a low threshold for onward referral. Time to change guidelines? First, chest tube drainage and hospitalization without recurrence prevention should no longer be standard treatment, as this has no advantage over the less invasive manual aspiration, which moreover can be performed on an outpatient basis in an important number of patients. The results of recent trials in conservative and ambulatory management are eagerly awaited. Second, shared decision-making should become more important with the well-informed patient, who may want to avoid a 1 in 3 recurrence rate and therefore will have the possibility to choose treatment including recurrence prevention even after the first episode of PSP. Third, surgical research should urgently make clear if the current practice of resection of emphysema-like changes is routinely necessary, alongside pleurodesis. Future studies should utilize risk stratification by clinical and radiological parameters (e.g., high-resolution computed tomography scanning and digital air leak monitoring) to predict short- and long-term outcomes, and hence personalize management.

BACKGROUND Parvovirus B19 (B19V) can cause severe anemia, hydrops foetalis, and even death in vulnerable patients. To prevent transfusion-transmitted B19V infection of at-risk patients, B19V antibody screening of blood donors was implemented. The cost-effectiveness of this intervention is unclear, as the likelihood of transmission through blood and subsequent complications for recipients are unknown. This study estimates the cost-effectiveness of anti-B19V donor screening in the Netherlands. STUDY DESIGN AND METHODS The estimates needed for the cost-effectiveness model were: the occurrence of B19V in Dutch blood donors, the number of anti-B19V tested products required by hospitals, the likelihood of morbidity and mortality given B19V infection, treatment costs, and screening costs. These estimates were obtained from literature and observational data. When data were unavailable, structured expert judgment elicitation and statistical modeling were applied. RESULTS The costs of preventing one transfusion transmitted B19V infection are estimated at €68,942 (€42,045 - €102,080). On average, 1.25 cases of morbidity and 0.12 cases of mortality are prevented annually. Although the perceived risk of transfusion transmitted B19V infection was low, half of the treating physicians favored anti-B19V screening. CONCLUSION The estimated mortality and morbidity caused by B19V infection was low in the risk groups. The cost-effectiveness ratio is similar to other blood safety screening measures. No guidance exists to evaluate the acceptability of this ratio. The explicit overview of costs and effects may further guide the discussion of the desirability of B19V safe blood products.

The different ways students deal with mistakes is an integral part of mindset theory. While previous error-monitoring studies found supporting neural evidence for mindset-related differences, they may have been confounded by overlapping stimulus processing. We therefore investigated the relationship between mindset and event-related potentials (ERPs) of error-monitoring (response-locked Ne, Pe), with and without overlap correction. In addition, besides behavioral measures of remedial action after errors (post-error slowing and accuracy), we investigated their neural correlates (stimulus-locked N2). Results indicated comparable Ne, but larger Pe amplitudes in fixed-minded students; however, after overlap correction, the Pe results were rendered non-significant. A likely explanation for this overlap was a near-significant effect of mindset on the preceding stimulus P3. Finally, although N2 was larger for trials following errors, mindset was unrelated. The current study shows that the relationship between error-monitoring and mindset is more complex and should be reconsidered. Future studies are advised to explore stimulus processing as well, and if needed, to correct for stimulus overlap. In addition, contextual influences on and individual variation in error-monitoring need more scrutiny, which may contribute to refining mindset theory.

Background: The value of neoadjuvant radiotherapy (RT) after 5-fluorouracil with leucovorin, oxaliplatin, and irinotecan, with or without dose modifications [(m)FOLFIRINOX], for patients with borderline resectable (BR) pancreatic ductal adenocarcinoma (PDAC) is uncertain. Methods: We conducted an international retrospective cohort study including consecutive patients with BR PDAC who received (m)FOLFIRINOX as initial treatment (2012–2019) from the Trans-Atlantic Pancreatic Surgery Consortium. Because the decision to administer RT is made after chemotherapy, patients with metastases or deterioration after (m)FOLFIRINOX or a performance score ≥2 were excluded. Patients who received RT after (m)FOLFIRINOX were matched 1:1 by nearest neighbor propensity scores with patients who did not receive RT. Propensity scores were calculated using sex, age (≤70 vs >70 years), WHO performance score (0 vs 1), tumor size (0–20 vs 21–40 vs >40 mm), tumor location (head/uncinate vs body/tail), number of cycles (1–4 vs 5–8 vs >8), and baseline CA 19-9 level (≤500 vs >500 U/mL). Primary outcome was overall survival (OS) from diagnosis. Results: Of 531 patients who received neoadjuvant (m)FOLFIRINOX for BR PDAC, 424 met inclusion criteria and 300 (70.8%) were propensity score–matched. After matching, median OS was 26.2 months (95% CI, 24.0–38.4) with RT versus 32.8 months (95% CI, 25.3–42.0) without RT (P=.71). RT was associated with a lower resection rate (55.3% vs 72.7%; P=.002). In patients who underwent a resection, RT was associated with a comparable margin-negative resection rate (>1 mm) (70.6% vs 64.8%; P=.51), more node-negative disease (57.3% vs 37.6%; P=.01), and more major pathologic response with P=.006). The OS associated with conventional and stereotactic body RT approaches was similar (median OS, 25.7 vs 26.0 months; P=.92). Conclusions: In patients with BR PDAC, neoadjuvant RT following (m)FOLFIRINOX was associated with more node-negative disease and better pathologic response in patients who underwent resection, yet no difference in OS was found. Routine use of RT cannot be recommended based on these data.

Background: As Western blood transfusion practices are changing, there is interest and need in anticipating the future demand of blood products and how a blood establishment can actively prepare for various long-term developments. This article provides an overview of how a scenario approach was used to prioritize key categories of drivers for the future demand of red blood cells and the organizational implications thereof for Sanquin, the Dutch national blood establishment. Study Design and Methods: Based on previously identified drivers from interviews and a literature review (Step 1), we conducted scenario sessions and a survey to rank a list of drivers (“themes”) with its related opportunities and threats (Step 2), to identify mitigating measures per theme through focus groups (Step 3). Results: In Step 2, 10 themes were found that were classified in terms of importance and uncertainty. These were plotted on a two-dimensional graph with an ellipse to indicate the interquartile ranges per theme. Experts rated the top three most important themes to be the blood supply organization, precision medicine, and red blood cell replacements. In Step 3, focus groups identified specific mitigating measures per theme. These measures had parallel ideas, such as the need for an innovative mentality, internal and external communication and collaboration, and building Sanquin's reputation and trust with the public. Conclusion: Having identified the most important themes with suggestions for mitigating measures, Sanquin can take steps to become adaptive and proactive. Other blood establishments may also use a scenario approach to create contextualized long-term strategies.

Additional file 1. Integrating oral health in porenatal care in-depth interview guide.

Background FOLFIRINOX is a standard treatment for metastatic pancreatic cancer patients. The effectiveness of neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer (BRPC) remains debated. Methods We performed a systematic review and patient-level meta-analysis on neoadjuvant FOLFIRINOX in patients with BRPC. Studies with BRPC patients who received FOLFIRINOX as first-line neoadjuvant treatment were included. The primary endpoint was overall survival (OS), and secondary endpoints were progression-free survival, resection rate, R0 resection rate, and grade III–IV adverse events. Patient-level survival outcomes were obtained from authors of the included studies and analyzed using the Kaplan-Meier method. Results We included 24 studies (8 prospective, 16 retrospective), comprising 313 (38.1%) BRPC patients treated with FOLFIRINOX. Most studies (n = 20) presented intention-to-treat results. The median number of administered neoadjuvant FOLFIRINOX cycles ranged from 4 to 9. The resection rate was 67.8% (95% confidence interval [CI] = 60.1% to 74.6%), and the R0-resection rate was 83.9% (95% CI = 76.8% to 89.1%). The median OS varied from 11.0 to 34.2 months across studies. Patient-level survival data were obtained for 20 studies representing 283 BRPC patients. The patient-level median OS was 22.2 months (95% CI = 18.8 to 25.6 months), and patient-level median progression-free survival was 18.0 months (95% CI = 14.5 to 21.5 months). Pooled event rates for grade III–IV adverse events were highest for neutropenia (17.5 per 100 patients, 95% CI = 10.3% to 28.3%), diarrhea (11.1 per 100 patients, 95% CI = 8.6 to 14.3), and fatigue (10.8 per 100 patients, 95% CI = 8.1 to 14.2). No deaths were attributed to FOLFIRINOX. Conclusions This patient-level meta-analysis of BRPC patients treated with neoadjuvant FOLFIRINOX showed a favorable median OS, resection rate, and R0-resection rate. These results need to be assessed in a randomized trial.

The aim of the study was to investigate trunk function during seated upper limb tasks in patients with spinal muscular atrophy types 2 and 3.Seventeen persons with spinal muscular atrophy and 15 healthy controls performed several tasks when sitting unsupported, such as reaching (and placing) forward and sideward. Joint torque and muscle activity were measured during maximum voluntary isometric contractions. Three-dimensional kinematics and normalized muscle activity were analyzed when performing tasks.Trunk joint torques were significantly decreased, approximately 45%, in patients with spinal muscular atrophy compared with healthy controls. Active range of trunk motion was also significantly decreased in all directions. When performing tasks, the average back muscle activity was 27% and 56% of maximum voluntary isometric contractions for healthy controls and spinal muscular atrophy and for abdominal muscles 10% and 44% of maximum voluntary isometric contractions, respectively. Trunk range of motion did not differ when performing daily tasks.The trunk of patients with spinal muscular atrophy is weaker compared with healthy controls, reflected by reduced trunk torques and decreased active range of motion. In addition, patients with spinal muscular atrophy use high percentages of their trunk muscle capacity to perform tasks. Clinicians should take this into account for intervention development, because using high percentages of the maximum muscle capacity results in fatigue and muscle overloading.

BACKGROUND: The importance of primary biliary cholangitis as an indication for liver transplantation has probably been influenced by the introduction of therapies, and changes in selection criteria and disease epidemiology.AIMS: To assess the time trends in liver transplantation for primary biliary cholangitis and to evaluate the characteristics of the patient population during the past three decades.METHODS: Patients undergoing liver transplantation from 1986 to 2015 in centres reporting to the European Liver Transplantation Registry were included. We excluded combined organ transplantations and patients RESULTS: We included 112 874 patients, of whom 6029 (5.3%) had primary biliary cholangitis. After an initial increase in the first decade, the annual number of liver transplantation for primary biliary cholangitis remained stable at around 200. The proportion of liver transplantations for primary biliary cholangitis decreased from 20% in 1986 to 4% in 2015 (P < 0.001). Primary biliary cholangitis was the only indication showing a consistent proportional decrease throughout all decades. From the first to the third decade, the age at liver transplantation increased from 54 (IQR 47-59) to 56 years (IQR 48-62) and the proportion of males increased from 11% to 15% (both P < 0.001).CONCLUSIONS: We have found a proportional decrease in primary biliary cholangitis as indication for liver transplantation. However, despite treatment with ursodeoxycholic acid and improved disease awareness, the absolute annual number of liver transplantations has stabilised.

Background Colorectal cancer (CRC) is a leading cause of cancer deaths worldwide. The endoplasmic reticulum unfolded protein response (UPRER) signal transducer activating transcription factor 6 (ATF6) is a clinically relevant pre-cancerous marker in CRC and colitis-associated CRC. We established the interrelated role of the microbiota and ATF6 signalling as a novel tumor-promoting mechanism in our transgenic mouse model of spontaneous microbiota-dependent ATF6-driven CRC (nATF6IEC). Methods To elucidate the transcriptional program initiated by acute and chronic ATF6 signalling, mRNA sequencing analyses of murine colonic intestinal epithelial cells were performed 4 days or 5 weeks after induction of ATF6, respectively. Germfree (GF) mice served to dissect microbiota contribution to the transcriptional response. CRC patient datasets (TCGA) were used to estimate ATF6 activity and validate ATF6-driven signatures. To investigate the impact of ATF6 signalling on metabolites, untargeted metabolomics of faeces and targeted lipidomics of tissue were performed. Mucosal microbiota was spatially characterised by 16S rRNA profiling at mm resolution along the colonic longitudinal axis. Based on 16S rRNA data, Phylogenetic Investigation of Communities Reconstruction of Unobserved States (PICRUSt2) was used to infer microbiota lipid-specific functional content. Results We identified an ATF6-UPR core of 368 differentially expressed genes fully activated by acute ATF6 signalling. Functional analysis using KEGG pathways showed that chronic ATF6 signalling predominantly alters UPR-related and metabolic pathways, with 22% of metabolic pathway genes classified as lipid metabolism. GF mice confirmed that the microbiota enhances ATF6-induced metabolic changes. Kaplan-Meier analyses significantly associate our microbiota-dependent ATF6-driven and lipid-specific ATF6-driven gene signatures with decreased disease-free survival in CRC patients since primary therapy. Moreover, ATF6 activity correlates with the presence of CRC-associated bacteria in TCGA samples. Tumor-susceptible mice show alterations in lipid metabolites, particularly long-chain fatty acids (FA) and elongation of saturated FA. PICRUSt2 revealed bacterial lipid detoxification mechanisms, with an increased total abundance of oleate hydratase-positive species. Conclusion Chronic ATF6-signalling alters host lipid metabolism and the lipid milieu in tumor-developing nATF6IEC mice. ATF6-driven microbiota changes are concomitant with bacterial lipid detoxification mechanisms in the tumor niche. We postulate that chronic ATF6 signalling represents a clinically relevant pathologic response that alters the intestinal lipid milieu and thus selects for a tumor-promoting microbiota.

Purpose: Multimorbidity, the simultaneous occurrence of more than 2 diseases, is no longer an exception. Especially non communicable chronic diseases like Osteoarthritis (OA), Diabetes mellitus Type 2 (DMT2), overweight (OW) and obesity (OB) as well as cardio-vascular diseases (CVD) are examples of the most prevalent chronic conditions in industrial nations. The treatment of multimorbidity has not gained much attention in research so far. Especially conservative therapies other than medication have not been established for this specific population. Physical exercise (PE) has been shown to be a treatment option with little adverse events and many positive effects for many single diseases, and physical activity (PA) promotion in general has found its way in many disease management programs. However, a shortfall of research on the effectiveness of specific PE interventions in the treatment of multimorbidity must be stated. The objective of this study therefore was to evaluate a pilot model aiming for behavior change towards the initiation and maintenance of regular PE and its related health benefits in patients with multimorbidity. This abstract focuses on a subsample of participants with knee osteoarthritis. Strength measures of the knee flexors and extensors and self-reported disease related symptoms were analyzed. Methods: Participants with at least two severe risk factors or manifested disease signs for hip and/or knee OA, DMT2, OW/OB, CVD were included in the study. The following analysis relates to the subsample of subjects with or at risk for knee OA. The intervention consisted of two 12-week successive phases. The first phase included different types of supervised aerobic and strength training sessions. Dosage parameters were based on the national PA recommendations. The intervention further comprised theoretical background information on training science, nutrition and behavioral change techniques as well as two personal counselling sessions with the aim to enable participants towards an autonomous exercise participation. The second intervention phase enhanced the self-organized maintenance of the same level of PE. In this phase, participants were contacted via email on a regular base. They received weekly training logs and feedback on their logs as well as another personal counselling session. Data were assessed at baseline (t0), after the first (t3) and after the second intervention phase (t6). Outcomes of this analysis relate to self-reported disease-related symptoms (WOMAC subscale pain and physical functioning) and isometric peak torque measures for knee flexion and extension. The study was conducted in two recruitment waves for organizational reasons. Due to the Covid-19 induced nationwide contact restrictions, strength measures could not be assessed for wave two at t3 in March 2020, therefore only t6 was used for further analysis of strength measures. Wilcoxon Tests were calculated for non-parametric data to assess the changes between t0-t3 and t0-t6. Effect sizes were calculated using r. The study is registered at the German clinical trial register (DRKS00016702). Results: N=39 patients were included in the study, thereof n=23 participants (females=19, males=4) showed disease signs or self-reported risk factors for knee OA. The mean BMI of them was 30.3 ± 3.2 kg/m2 and the mean age was 58.3 ± 6.3 years. Of the subsample, n=22 were also overweight or obese, n=16 had a diagnosis of hypertension, n=2 were diagnosed with DMT2 and n=16 had an elevated risk for DMT2. The WOMAC score was not answered by three participants at t3. One participant did not perform the knee extension test due to pain at t0 and t6. One participant did not perform the isometric torque at t6 due to an elevated blood pressure. 2 participants were lost to follow-up due to family illness (n=1) and shortage of time caused by Covid-19 induced overtime (n=1) and did not provide any data at t6. Median values for WOMAC pain decreased from t0 to t3 but not from t0 to t6, this was not statistically significant. The decrease for the subscale physical function from t0 to t3 and t6 was not statistically significant as well (Table 1). [Formula presented] There was a statistically significant change for isometric peak torque of knee extension. Strength values for knee flexion increased as well, however this was not statistically significant (Table 2, Figure 1). [Formula presented] [Formula presented] Conclusions: Results of this study indicate that a systematic, initially supervised training can lead to objective health benefits in people with knee OA and multimorbidity. Participants of the study showed an increase in maximal isometric force of knee extension with a large effect size. This is an important finding for patients with risk factors as well as already manifested knee OA, as quadriceps strength is known as a protective factor for knee OA and its progression. Results for the WOMAC showed marginal improvement throughout the intervention period. The majority of people only had minor complaints at the beginning of the study, reducing the potential for positive change. One limitation of the study is the onset of the Covid-19 related contact restrictions that prohibited strength measures as well as physical exercise training sessions in gyms and other public places for participants of wave 2 from the 9th intervention week on. The influence of this force majeure on the results of the study cannot be conclusively assessed at this point. Further limitations are related to the small sample size, especially for the subgroup of patients with OA, and the lack of a control group. This was a pilot study for a randomized controlled trial in health services research which is already initiated. Results of this pilot trial therefore indicate the feasibility and the potential benefit of this intervention for multimorbid patients with knee OA that will now be implemented and evaluated in a real health services setting in the near future.

Item does not contain fulltext The aim of this research was to study impairments, activity limitations and participation restrictions due to upper limb involvement in people with four different types of neuromuscular disorders (NMD) - FacioScapuloHumeral Dystrophy (FSHD), Limb-Girdle Muscular Dystrophy (LGMD), Spinal Muscular Atrophy (SMA) and Duchenne Muscular Dystrophy (DMD) - and to investigate whether common or different profiles could be identified. Total of 267 respondents with NMD from the Netherlands answered a set of questionnaires covering upper limb impairments (pain and stiffness), activity limitations and participation restrictions. Pain was most often reported by persons with FSHD. Problems in the FSHD group were mainly characterized by relatively high scores for pain and stiffness and low scores for activity limitations. People with LGMD reported also low scores for activity limitations. Conversely, people with SMA and DMD experienced in general relatively low scores for pain and stiffness and high scores for activity limitations. Although people with FSHD and LGMD had relatively few activity limitations, all NMD groups experienced restrictions when participating in social activities. Our results indicate specific profiles of upper limb function in different types of NMD. While the profile observed in persons with FSHD seems to reflect overuse, the profile seen in persons with DMD and SMA is suspicious of disuse, each requiring a specific rehabilitation strategy.

Objective: To assess the prospective risk of developing substance-related disorders after childhood mental health disorders (i.e., attention-deficit/hyperactivity disorder [ADHD], oppositional defiant disorder [ODD] or conduct disorder [CD], anxiety disorder, and depression) using meta-analysis. Method: PubMed, Embase, and Psyclnfo were searched for relevant longitudinal studies that described childhood (

Spatial Data Infrastructures (SDIs) aim at making spatial (geographical) data and thus content available for the benefit of the economy and of the society. Agreement and sharing of vocabularies within the SDI are vital for interoperability. But there is a limitation: many vocabularies have been defined within domains while other domains have not been taken into account. Therefore, little harmonisation has been achieved and data sharing between domains within the SDI is problematic. This paper presents a methodology and tools for non-automatic, community driven ontology matching that we developed to harmonise the definition of concepts in domain models that are already being defined and used in operational use cases. Besides the methodology and tools that we developed, we describe our experiences and lessons learned as well as future work.

Increasing identification of transmissions of emerging infectious diseases (EIDs) by blood transfusion raised the question which of these EIDs poses the highest risk to blood safety. For a number of the EIDs that are perceived to be a threat to blood safety, evidence on actual disease or transmission characteristics is lacking, which might render measures against such EIDs disputable. On the other hand, the fact that we call them "emerging" implies almost by definition that we are uncertain about at least some of their characteristics. So what is the relative importance of various disease and transmission characteristics, and how are these influenced by the degree of uncertainty associated with their actual values? We identified the likelihood of transmission by blood transfusion, the presence of an asymptomatic phase of infection, prevalence of infection, and the disease impact as the main characteristics of the perceived risk of disease transmission by blood transfusion. A group of experts in the field of infectious diseases and blood transfusion ranked sets of (hypothetical) diseases with varying degrees of uncertainty associated with their disease characteristics, and used probabilistic inversion to obtain probability distributions for the weight of each of these risk characteristics. These distribution weights can be used to rank both existing and newly emerging infectious diseases with (partially) known characteristics. Analyses show that in case there is a lack of data concerning disease characteristics, it is the uncertainty concerning the asymptomatic phase and the disease impact that are the most important drivers of the perceived risk. On the other hand, if disease characteristics are well established, it is the prevalence of infection and the transmissibility of the disease by blood transfusion that will drive the perceived risk. The risk prioritization model derived provides an easy to obtain and rational expert assessment of the relative importance of an (emerging) infectious disease, requiring only a limited amount of information. Such a model might be used to justify a rational and proportional response to an emerging infectious disease, especially in situations where little or no specific information is available.

Approximately 20% of pancreatic ductal adenocarcinoma (PDAC) patients have (borderline) resectable pancreatic cancer [(B)RPC] at diagnosis. Upfront resection with adjuvant chemotherapy has long been the standard of care for these patients. However, although surgical quality has improved, still about 50% of patients never receive adjuvant treatment. Therefore, recent developments have focused on a neoadjuvant approach. Directly comparing results from neoadjuvant and adjuvant regimens is challenging due to differences in patient populations that influence outcomes. Neoadjuvant trials include all patients who have (B)RPC on imaging, while adjuvant-only trials include patients who underwent a complete resection and recovered to a good performance status without any evidence of residual disease. Guidelines recommend neoadjuvant treatment for BRPC patients mainly to improve negative resection margin (R0) rates. For resectable PDAC, upfront resection is still considered the standard of care. However, theoretical advantages of neoadjuvant treatment, including the increased R0 resection rate, early delivery of systemic therapy to all patients, directly addressing occult metastatic disease, and improved patient selection for resection, may also apply to these patients. A systematic review by intention-to-treat showed a superior median overall survival (OS) for any neoadjuvant approach (19 months) compared to upfront surgery (15 months) in (B)RPC patients. A neoadjuvant approach was recently supported by three randomized controlled trials (RCTs). For resectable PDAC, neoadjuvant treatment was superior in a Japanese RCT of neoadjuvant gemcitabine with S-1 vs. upfront surgery, with adjuvant S-1 in both arms (median OS: 37 vs. 27 months, p = 0.015). A Korean trial of neoadjuvant gemcitabine-based chemoradiotherapy vs. upfront resection in BRPC patients was terminated early due to superiority of the neoadjuvant group (median OS: 21 vs. 12 months, p = 0.028; R0 resection: 52 vs. 26%, p = 0.004). The PREOPANC-1 trial for (B)RPC patients also showed favorable outcome for neoadjuvant gemcitabine-based chemoradiotherapy vs. upfront surgery (median OS: 17 vs. 14 months, p = 0.07; R0 resection: 63 vs. 31%, p < 0.001). FOLFIRINOX is likely a better neoadjuvant regimen, because of superiority compared to gemcitabine in both the metastatic and adjuvant setting. Currently, five RCTs evaluating neoadjuvant modified or fulldose FOLFIRINOX are accruing patients.

In order to prevent iron deficiency, Sanquin—the national blood bank in the Netherlands—measures a blood donor’s hemoglobin (Hb) level before each donation and only allows a donor to donate blood if their Hb is above a certain threshold. In around 6.5% of blood bank visits by women, the donor’s Hb is too low and the donor is deferred from donation. For visits by men, this occurs in 3.0% of cases. To reduce the deferral rate and keep donors healthy and motivated, we would like to identify donors that are at risk of having a low Hb level. To this end we have historical Hb trajectories at our disposal, i.e., time series consisting of Hb measurements recorded for individual donors.

Background Therapeutic management of the upper extremity (UE) function of people with spinal muscular atrophy (SMA) requires sensitive and objective assessment. Therefore, we aimed to measure physiologic UE function of SMA patients with different functional abilities and evaluate the relation between these physiologic measures and functional UE scales. Methods 12 male and 5 female SMA patients (mean age 42 years; range 6–62 years) participated in this explorative study. Concerning the physiologic level, the maximal muscle torque, the maximal and normalized surface electromyography (sEMG) amplitudes, and the maximal passive and active joint angles were measured. Concerning the activity level, the Performance of the Upper Limb (PUL) scale was used, and hand function was examined using the Nine-Hole Peg Test and the Timed Test of In-Hand Manipulation (TIHM). Results Outcome measures that significantly related to the functional ability were: the PUL score (all dimensions); the finger to palm task of the Timed TIHM; biceps, triceps, and forearm extensor strength; and the active range of motion of shoulder abduction, shoulder flexion, and wrist extension. In addition, the following physiologic variables were related to the activity level (PUL score): hand function (the Nine-Hole Peg Test; Rs = − 0.61), the Timed TIHM (Rs = − 0.53), the maximal muscle torque (Rs = 0.74), the maximal sEMG amplitude (Rs = 0.79), and the maximal active joint angle (Rs = 0.88). Conclusions Muscle functions in SMA patients are already affected before activity limitations are noticeable. Consequently, monitoring the maximal muscle strength and the normalized muscle activity during task performance could play a role in the early detection of UE limitations. The mechanism behind the loss of arm activities due to SMA is primarily caused by decreasing muscle capacity, which influences the ability to move an arm actively. In clinical practices, these dimensions should be considered separately when monitoring disease progression in order to better evaluate the need for interventions.